Screening student drinking behaviors: examining AUDIT criterion validity using CIDI-based alcohol use disorder as the 'gold standard'.

Introduction: High levels of alcohol consumption among college students have been observed across countries. Heavy drinking episodes are particularly prevalent in this population, making early identification of potentially harmful drinking critical from a public health perspective. Short screening instruments such as the Alcohol Use Disorders Identification Test (AUDIT) are serviceable in this regard. However, there is a need for studies investigating the criterion validity of AUDIT in the student population. The aim was to examine the criterion validity of the full AUDIT and AUDIT-C (the first three items directly gauging consumption patterns) in a sample of college and university students using 12-month prevalence of alcohol use disorder derived from an electronic, self-administered version of the World Health Organization (WHO) Composite International Diagnostic Interview, fifth version (CIDI 5.0), which serves as the 'gold standard'. Methods: The study population of the current study is derived from the SHoT study (Students' Health and Wellbeing Study), which is a large national survey of students enrolled in higher education in Norway. In a follow-up study of mental disorders among participants of the SHoT2022 study, students were invited to complete a self-administered electronic version of the CIDI. A random sample of 4,642 participants in the nested CIDI-sample was asked to fill out a set of screening instruments, including AUDIT, before starting CIDI. Based on Youden Index maximization, we estimated the sex-specific optimal cut-offs for AUDIT and AUDIT-C in relation to alcohol use disorder, as determined by CIDI. Results: For the full AUDIT, the optimal cut-offs were 9 for males and 10 for females. The corresponding cut-offs for AUDIT-C were 6 for males and 5 for females. The same optimal cut-offs for both the full AUDIT and AUDIT-C were replicated in bootstrapped analyses with 1,000 runs. Conclusion: The full AUDIT demonstrated acceptable criterion validity with a balance between sensitivity and specificity. However, for AUDIT-C, caution should be exercised when interpreting screening results among college and university students. In conclusion, the full AUDIT is a reliable screening instrument for college and university students, while further modification may be needed for AUDIT-C in this setting.

Examining the relationship between non-suicidal self-harm and suicidality within the past 12-months and gaming problems in Norwegian full-time students.

BACKGROUND: Although gaming problems are associated with poor mental health, few population-based studies have examined its association with self-harm and suicidality. This study investigates the association between gaming problems, non-suicidal self-harm and suicidality within the past year, stratified by sex among Norwegian full-time students. METHODS: Data derived from the Norwegian Students' Health and Wellbeing Study 2022 (N = 59,544). The respondents were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers based on the Game Addiction Scale for Adolescents. Log-link binomial regression models, stratified by sex, adjusted for age, were used to estimate the risk ratio of non-suicidal self-harm (ideation and behavior) and suicidal behaviors (ideation and attempt) across different levels of gaming problems. RESULTS: Among females, the risk of non-suicidal self-harm and suicidal ideation increased from non-gamer to problem gamer, with no differences between problem and addicted gamers. Among males, the risk of non-suicidal self-harm increased from non-gamers to engaged gamers, but no differences were observed between engaged, problematic, and addicted gamers. No sex × gaming category interaction was observed for suicide attempts. Engaged and addicted gamers had higher risks of suicide attempt than non-gamers and recreational gamers. CONCLUSIONS: Gaming problems are associated with increased risk of non-suicidal self-harm and suicidal ideation among females. Among males, no differences were observed between engaged, problem and addicted gamers. The results highlight sex when studying health related outcomes and their association to level of gaming problems. Longitudinal studies are warranted to uncover the temporal mechanisms between IGD, non-suicidal self-harm and suicidality.

Sleep duration and mental health in young adults.

BACKGROUND: The association between sleep duration and mental illness has been established in middle-aged and older populations, yet remains less explored in younger adults. Additionally, a common limitation to existing studies is the lack of statistical power to explore less common disorders. The purpose of this study was to examine sleep duration as a predictor for a range of mental disorders and well-being in a longitudinal sample of young adults. METHODS: Data were derived from two waves (w1, w2) of the SHoT survey, which invited all full-time university and college students in Norway. The response rates were 34.4 % (n = 62,498) in 2021 (w1) and 35.1 % (n = 59,554) 2022 (w2). This study utilized a nested longitudinal sample from both w1 and w2, encompassing 21,289 students. Demographics, sleep duration (w1), and mental health (w2) were measured by self-report questionnaires. Sex-stratified linear regression models and log-link binomial regression analyses were employed to determine the proportion and calculate the risk ratios, respectively, for mental illness across different sleep duration categories. RESULTS: The mean age of the sample was 24.8 years ± 4.5 years (w1). Students with shorter sleep durations, and to some degree longer sleep durations (illustrating a ᒐ-shaped association), exhibited a higher risk for all assessed mental disorders and well-being outcomes one year later, compared to students sleeping 8-9 h. The ᒐ-shaped trend was consistent for both female and male students. CONCLUSION: Sleep duration appears to be a transdiagnostic marker for mental health in young adults.

Prospective associations between adolescent risky substance use and school dropout and the role of externalising and internalising problems.

Background: The aim of the present study was to assess to what extent risky substance use (RSU) acts as an important risk factor for school dropout from upper secondary school in a prospective study of Norwegian adolescents, and how externalising and internalising mental health problems influenced this association. Methods: We used data from a large population-based survey (the youth@hordaland-survey), which included adolescents aged 16-19 years. The predictor variables were self-reported RSU. The survey was linked with prospective data from the Norwegian Education Database, following the adolescents to 21-23 years of age. The outcome variable was registry-based school dropout within five years after starting upper secondary school. The analyses were adjusted for sex, age, socioeconomic status, and externalising and internalising problems. Results: After adjustment for sociodemographic variables, all indicators of RSU were prospectively associated with school dropout (adjusted odds ratios 1.26-2.25; all p values <.01). While internalising problems only slightly changed these estimates, the associations were substantially attenuated by externalising problems. Still, all measures of RSU, except frequent alcohol intoxication, remained positively associated with school dropout in the fully adjusted models. For the youngest students, all associations between RSU and school dropout were significant. Conclusions: Adolescent RSU is a strong predictor for school dropout, and externalising problems explained a considerable proportion of this effect. Prevention efforts to reduce student substance could improve academic outcomes among upper secondary school students, and such efforts may benefit from also targeting co-occurring externalising problems.

Secular trends in mental health problems among young people in Norway: a review and meta-analysis.

There is a growing concern that the mental health of recent generations of youth is deteriorating, yet the etiology of these secular changes is not fully understood. We aimed to review the evidence on trends in mental health problems among young people in Norway. Seven large-scale repeated cross-sectional studies were included in this study, comprising 35 cross-sectional data collections between 1992 and 2019, with a total sample of 776,606 young people. Our study found a clear increase in mental health problems among young females in Norway over the past few decades, while the trends were less marked for males. The proportion of individuals scoring above the problematic symptom score threshold increased on average by 11.2% (range 2.2% to 21.9%) for females and 5.2% (range - 0.9% to 11.1%) for males, based on data from the individual studies. The results from a meta-regression analysis showed that across all surveys, mean symptom scores increased by 17% (95% CI 12 to 21%) among females and 5% (95% CI 1 to 9%) among males from 1992 to 2019. Overall, mental health problems have increased continually since the early 1990s among young people, especially among young females. The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.Protocol registration: Open science framework, November 8, 2021 ( https://osf.io/g7w3v ).

Energy drink consumption and sleep parameters in college and university students: a national cross-sectional study.

OBJECTIVES: To investigate the frequency of energy drink (ED) consumption, and the association between ED consumption and selected sleep characteristics and parameters in Norwegian college and university students. We also explored whether these associations varied based on sex. DESIGN: Cross-sectional. SETTING: Data were gathered from the SHOT2022 study (Students' Health and Well-being Study), a national survey. PARTICIPANTS: 53 266 students, aged 18-35 years, enrolled in higher education in Norway (2022). MAIN OUTCOME MEASURES: Estimated marginal means were computed from general linear models investigating the association between ED consumption and continuous sleep outcomes, while log-link binomial regression analysis was used for dichotomous sleep outcomes of sleep measures. All models were adjusted for age. RESULTS: Among the participants, 4.7% of men and 3.3% of women reported consuming ED daily. The frequency of ED consumption was inversely associated with sleep duration and sleep efficiency, while a direct association was observed with the frequency of ED consumption and sleep patterns such as sleep onset latency and wake after sleep onset across sexes. The strongest association was found between daily ED consumption and short sleep duration where men had a risk ratio (RR) of 2.07; 95% CI 1.77 to 2.42, and women had a RR of 1.87; 95% CI 1.64 to 2.14. CONCLUSION: ED consumption was a strong determinant for negative sleep outcomes. Even small amounts of ED were associated with poorer sleep outcomes, which warrant more attention towards the consequences of consuming ED among college and university students.

Mental health problems and suicidal behavior from adolescence to young adulthood in college: linking two population-based studies.

It is well established that mental health problems are highly recurrent and persistent from childhood to adolescence, but less is known to what extent mental health problems also persist from adolescence into young adulthood. The aim of the current study was therefore to examine the chronicity and risk of mental health problems and suicidality from adolescence to young adulthood. Data stem from two Norwegian population-based studies conducted 6 years apart; the youth@hordaland study from 2012 (age 16-19) and the SHoT2018 study (age 22-25). These two data sources were linked to produce a longitudinal sample of 1257 individuals. A wide range of self-reported mental health and suicidality instruments (used both continuously and categorically) were analyzed using log-link binomial regression analysis, adjusting for age, sex, parental education, and financial problems. We found that high levels of mental health problems in late adolescence were a significant risk factor for reporting poor mental health 6 years later. Internalizing and externalizing problems in adolescence were associated with a 2.8-fold and 1.9-fold increased risk, respectively, of reporting a mental disorder 6 years later. Similarly, self-harm in adolescence was associated with a 2.1-fold increased risk of suicidal thoughts 6 years later. The magnitudes of the adjusted risk ratios were generally similar across the various mental health and suicidality measures used at the two assessment points. Adjustment for confounders did not, or only slightly, attenuate the risk ratios, and all associations remained statistically significant in the adjusted analyses. This longitudinal study provides new evidence of the chronicity of mental health problems and suicidality from adolescence to adulthood in Norway. The results emphasize the importance of early identification and timely interventions to reduce the prevalence and impact of mental health problems and suicidality.

Sleep and childhood maltreatment: A matched-control study of sleep characteristics in Norwegian 16-19-year-olds.

Sleep problems are an important but understudied health problem in adolescents exposed to childhood maltreatment. The current study aimed to examine sleep characteristics and insomnia in a population with maltreatment history and compare them to a general population sample of adolescents. Data from a sample of Norwegian 16-19-year-old adolescents with childhood maltreatment experiences (n = 62) were linked to an age- and sex-matched general population sample (n = 238). Independent samples t tests were used to compare the two groups on several detailed sleep parameters, while general linear models were used to control for mental health problems, assessed by the Strengths and Difficulties Questionnaire. Mental health was examined as a potential mediator between childhood maltreatment and sleep characteristics. Adolescents exposed to childhood maltreatment had longer sleep onset latency (1:15 h vs. 47 min, p < 0.001), longer wake after sleep onset (34 min vs. 15 min, p < 0.003), lower sleep efficiency in weekdays (77.8%, vs. 85%, p < 0.007), and lower sleep efficiency in weekends (81.8% vs. 88.9%, p < 0.001) than the reference group. Mental health problems fully mediated the association between childhood maltreatment exposure and longer sleep onset latency and wake after sleep onset. The rate of insomnia did not significantly differ between the groups. This study suggests that older adolescents exposed to childhood maltreatment have more sleep problems than the general adolescent population, and that these problems may be explained by co-existing mental health problems. These findings highlight the potential utility of assessing and providing sleep-focused treatment to adolescents with a history of childhood maltreatment and mental health problems.

Reexploring Problematic Social Media Use and Its Relationship with Adolescent Mental Health. Findings from the "LifeOnSoMe"-Study.

Purpose: Previous approaches used to assess problematic social media use risk inflating prevalence numbers and classifying unproblematic social media use as problematic. The main aim of this study was to take an exploratory view as to how different types of activities, experiences, and motivations on social media are associated with problematic mental health outcomes in adolescents. Patients and Methods: This study is based on a cross-sectional survey of 2023 adolescents (mean age 17.4 years (SD 0.9), 44.4% males) from the year 2020. Exploratory graph analysis and exploratory factor analysis were performed on 28 pre-selected items assessing adolescents' use of social media, to identify underlying potentially problematic factors associated with social media use. Sets of gender-adjusted multiple linear regression analyses were performed to assess the degree to which social media factors predicted depression, anxiety, well-being, and time spent on social media. Results: Three factors were identified: 1) "subjective overuse", 2) "social obligations", and 3) "source of concern". All three factors showed significant positive associations with mental health problems. The factor "source of concern", which identifies feelings of being overwhelmed and concerned over social media use, had the strongest association to mental health problems and simultaneously the weakest association to time spent on social media. Conclusion: Three identified factors measuring problematic social media use showed positive associations with mental health problems. This lends support to the notion that problematic social media use is a multidimensional phenomenon and demonstrates the need to move beyond addiction criteria when assessing problematic social media use.

Prevalence of mental disorders among Norwegian college and university students: a population-based cross-sectional analysis.

Background: Self-report data indicate a sharp increase in mental health problems among college and university students in recent years, but accurate prevalence estimates of mental disorders are lacking. The current study used a validated psychiatric diagnostic survey, developed into a self-administered electronic version, to examine the prevalence of common mental disorders in a large national sample of college and university students in Norway. Methods: Participants (aged 18-35 years) from the national Students' Health and Wellbeing (SHOT) Study in 2022 were recruited to a follow-up online survey of mental disorders from January to February 2023 (n = 10,460). Current (30-days), 12-months and lifetime prevalence of common mental disorders were examined using a newly developed self-administered electronic version of the Composite International Diagnostic Interview (CIDI 5.0). Findings: The prevalence of a current mental disorder was high for both women (39.7% [2737/6886], 95% CI 38.6-40.9) and men (25.7% [751/2918], 95% CI 24.2-27.4). The most common disorders were major depressive episode (females 17.1% [1250/7329] and males 10.8% [331/3059]) and generalized anxiety disorder (females 16.0% [1157/7221] and males 8.2% [250/3032]), while 5.6% [387/6948] and 7.7% [228/2963] of the females and male students, respectively, fulfilled the criteria for an alcohol use disorder. The prevalence estimates for 12-month and lifetime were, as expected, even higher. Interpretation: The findings suggest an alarmingly high prevalence of several mental disorders among Norwegian college and university students. Implications and potential methodological and contextual explanations of these findings are discussed. Funding: Norwegian Ministry of Education and Research.

Dysfunctional beliefs and attitudes about sleep (DBAS) mediate outcomes in dCBT-I on psychological distress, fatigue, and insomnia severity.

OBJECTIVE/BACKGROUND: Digital cognitive behavioral therapy for insomnia (dCBT-I) improves several sleep and health outcomes in individuals with insomnia. This study investigates whether changes in Dysfunctional Beliefs and Attitudes about Sleep (DBAS) during dCBT-I mediate changes in psychological distress, fatigue, and insomnia severity. PATIENTS/METHODS: The study presents a secondary planned analysis of data from 1073 participants in a randomized control trial (Total sample = 1721) of dCBT-I compared with patient education (PE). Self-ratings with the Dysfunctional Beliefs and Attitudes about Sleep (DBAS), the Hospital Anxiety Depression Scale (HADS), the Chalder Fatigue Scale (CFQ), and the Insomnia Severity Index (ISI) were obtained at baseline and 9-week follow-up. Hayes PROCESS mediation analyses were conducted to test for mediation. RESULTS AND CONCLUSION: sDBAS scores were significantly reduced at 9-week follow-up for those randomized to dCBT-I (n = 566) compared with PE (n = 507). The estimated mean difference was -1.49 (95% CI -1.66 to -1.31, p < .001, Cohen's d. = 0.93). DBAS mediated all the effect of dCBT-I on the HADS and the CFQ, and 64% of the change on the ISI (Estimated indirect effect -3.14, 95% CI -3.60 to -2.68) at 9-week follow-up compared with PE. Changes in the DBAS fully mediated the effects of dCBT-I on psychological distress and fatigue, and the DBAS partially mediated the effects on insomnia severity. These findings may have implications for understanding how dCBT-I works and highlights the role of changing cognitions in dCBT-I.

Sleep and dropout from upper secondary school: A register-linked study.

OBJECTIVE: The present study investigates the association between sleep in late adolescence and completion of upper secondary school. METHODS: The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked with official educational data in Norway (N = 8838). RESULTS: High school dropout was more prevalent among adolescents who had insomnia (20.6%) compared to those without insomnia (14.3%; adjusted risk ratios = 1.50; 95% confidence intervals: [2.19-2.92]). There was also a higher rate of school dropout among those who had symptoms of delayed sleep-wake phase (21%) compared to those without delayed sleep-wake phase (14.3%); adjusted risk ratios = 1.43, 95% confidence intervals: (1.28-1.59). School noncompleters were also characterized by reporting 44 minutes shorter sleep duration, longer sleep onset latency, and wake after sleep onset (both approx. 15 minutes) compared to school completers. CONCLUSION: The importance of sleep for high school dropout rates highlights the importance of including sleep as a risk indicator and a possible target for preventive interventions in late adolescence.

Later school start time is associated with longer school day sleep duration and less social jetlag among Norwegian high school students: Results from a large-scale, cross-sectional study.

The present study explored the associations between school start time and sleep habits among older adolescents, and whether these associations depended on circadian preference. The sample comprised 4010 high school students aged 16-17 years who completed a web-based survey on habitual school start time, sleep, and health. The survey included the Munich ChronoType Questionnaire, and the short version of the Horne-Östberg Morningness-Eveningness Questionnaire. Students were categorised according to habitual school start time (before 08:00 hours, 08:00 hours, 08:15 hours, 08:30 hours or after 08:30 hours) and circadian preference (morning, intermediate or evening). Data were analysed using two-way analyses of variance (school start time × circadian preference) and linear regression analyses. Results showed an overall effect of school start time on school day sleep duration (main effect, p < 0.001), with the latest school starters having the longest, and the earliest school starters having the shortest sleep duration (7:03 hr versus 6:16 hr; Tukey HSD p < 0.001). Similarly, later school starters generally reported shorter social jetlag and later school day wake-up times than earlier starting students (both main effect p < 0.001). Circadian preference did not modify these associations (interaction effects p > 0.05). In the crude regression analysis, 15 min later school start was associated with 7.2 min more sleep (p < 0.001). School start time remained a significant predictor of school day sleep duration when adjusted for sex, parental educational level and circadian preference (p < 0.001). Results suggest that school start time is a significant predictor of school day sleep duration among adolescents.

Psychosocial working conditions and sickness absence among younger employees in Denmark: a register-based cohort study using job exposure matrices.

OBJECTIVE: Previous literature has established associations between psychosocial working conditions and sickness absence (SA), but only few studies have examined associations among younger employees. This study aimed to investigate associations between psychosocial working conditions and SA among employees, aged 15-30 years, who entered the labor market in Denmark between 2010 and 2018. METHOD: We followed 301 185 younger employees in registers for on average 2.6 years. Using job exposure matrices, we assessed job insecurity, quantitative demands, decision authority, job strain, emotional demands, and work-related physical violence. Adjusted rate ratios of SA spells of any length were estimated for women and men separately with Poisson models. RESULTS: Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Being employed in occupations with high versus low emotional demands showed the strongest association with SA, with a rate ratio of 1.44 [95% confidence interval (CI) 1.41-1.47]. Among men, being employed in occupations with low decision authority showed the strongest association with SA (1.34, 95% CI 1.31-1.37), whereas occupations with high quantitative demands, high job strain, and high emotional demands were associated with lower rates of SA. CONCLUSION: We found that several psychosocial working conditions were associated with SA spells of any length. Associations with SA spells of any length resemble associations with long-term SA, suggesting that results from previous studies on long-term SA may be generalizable to all lengths of SA among younger employees.

Digital cognitive behaviour therapy for insomnia in individuals with self-reported insomnia and chronic fatigue: A secondary analysis of a large scale randomized controlled trial.

Insomnia is associated with fatigue, but it is unclear whether response to cognitive behaviour therapy for insomnia is altered in individuals with co-occurring symptoms of insomnia and chronic fatigue. This is a secondary analysis using data from 1717 participants with self-reported insomnia in a community-based randomized controlled trial of digital cognitive behaviour therapy for insomnia compared with patient education. We employed baseline ratings of the Chalder Fatigue Questionnaire to identify participants with more or fewer symptoms of self-reported chronic fatigue (chronic fatigue, n = 592; no chronic fatigue, n = 1125). We used linear mixed models with Insomnia Severity Index, Short Form-12 mental health, Short Form-12 physical health, and the Hospital Anxiety and Depression Scale separately as outcome variables. The main covariates were main effects and interactions for time (baseline versus 9-week follow-up), intervention, and chronic fatigue. Participants with chronic fatigue reported significantly greater improvements following digital cognitive behaviour therapy for insomnia compared with patient education on the Insomnia Severity Index (Cohen's d = 1.36, p < 0.001), Short Form-12 mental health (Cohen's d = 0.19, p = 0.029), and Hospital Anxiety and Depression Scale (Cohen's d = 0.18, p = 0.010). There were no significant differences in the effectiveness of digital cognitive behaviour therapy for insomnia between chronic fatigue and no chronic fatigue participants on any outcome. We conclude that in a large community-based sample of adults with insomnia, co-occurring chronic fatigue did not moderate the effectiveness of digital cognitive behaviour therapy for insomnia on any of the tested outcomes. This may further establish digital cognitive behaviour therapy for insomnia as an adjunctive intervention in individuals with physical and mental disorders.

Does It Matter Who You Provide Care for? Mental Health and Life Satisfaction in Young Adult Carers Associated with Type of Relationship and Illness Category-A National Student Survey.

There is limited knowledge on how caring contexts impact young adults providing informal care for persons with chronic conditions. This study examines associations between outcomes in young adult carers (YACs) and type of relationship (e.g., close or distant family member, partner, or someone outside the family) and type of illness in the care-receiver (e.g., mental, physical illness/disability, or substance abuse). A total of 37,731 students (age 18-25, mean 22.3 years, 68% females) in higher education in Norway completed a national survey on care responsibilities, hours of daily caring, relationship and type of illness, mental health problems (Hopkins Symptoms Checklist-25) and life satisfaction (Satisfaction With Life Scale). More mental health problems and lower life satisfaction were found among YACs compared to students without care responsibilities. The poorest outcomes were reported by YACs caring for a partner, followed by YACs caring for a close relative. Hours spent on daily caring was highest when caring for a partner. Poorer outcomes were reported by YACs caring for someone affected by substance abuse, followed by mental health problems and physical illness/disability. At-risk groups among YACs should be acknowledged and offered support. Future studies are needed to investigate the potential mechanism for the associations between care context variables and YAC outcomes.

Marital status and gambling disorder: a longitudinal study based on national registry data.

BACKGROUND: Marital status is a robust correlate of disordered gambling, but few studies have examined the direction of this association. METHODS: The present study used a case-control design by including all adults receiving their first gambling disorder (GD) diagnosis between January 2008 to December 2018 (Norwegian Patient Registry, n = 5,121) and compared them against age and gender matched individuals with other somatic/psychiatric illnesses (Norwegian Patient Registry, n = 27,826) and a random sample from the general population (FD-Trygd database, n = 26,695). The study examined marital status before GD, getting divorced as a risk factor for future GD, and becoming married as a protective factor of future GD. RESULTS: The findings indicated an 8-9 percentage points higher prevalence of unmarried people and about a 5 percentage points higher prevalence of separation/divorce among those that subsequently experienced GD compared to controls. Logistic regressions showed that transition through divorce was associated with higher odds of future GD compared to illness controls (odds ratio [OR] = 2.45, 95% CI [2.06, 2.92]) and the general population (OR = 2.41 [2.02, 2.87]). Logistic regressions also showed that transition through marriage was associated with lower odds of future GD compared to illness controls (OR = 0.62, CI [0.55, 0.70]) and the general population (OR = 0.57, CI [0.50, 0.64]). CONCLUSIONS: Social bonds have previously been shown to impact physical and mental health, and the findings of the study emphasize the importance of considering social network history and previous relationship dissolution among individuals with GD.

Establishing the Association Between Snus Use and Mental Health Problems: A Study of Norwegian College and University Students.

INTRODUCTION: Smoking and mental health problems are public health concerns worldwide. Studies on smoke-free tobacco products, especially snus are scarce. Snus is considered less harmful than smoking and in the United States allowed to be marketed accordingly, but may still add to the burden of disease. AIMS AND METHODS: Data stem from the Norwegian Students' Health and Wellbeing Study (SHoT study) in 2018 (162 512 invited, 50 054 (30.8%) completed). Smoking, snus use, health service and medication usage and mental health problems, including the Hopkins Symptom Checklist-25 (HSCL-25), were assessed using self-report. The aims were to explore the associations between smoking and snus use and mental health problems and treatments. Furthermore, the association between both daily smoking and daily snus use and mental health problems. Associations were tested with χ2-, t-tests, and logistic regression. RESULTS: Daily snus users had 38% increased odds (odds ratio [OR]: 1.38, CI: 1.30 to 1.46), and daily smokers had 96% increased odds (OR: 1.96, CI: 1.65 to 2.34) of having a high HSCL-25 score, adjusted for gender, low socioeconomic status (SES), using tobacco, participating in therapy and using antidepressants daily. CONCLUSIONS: Both daily smoking and daily snus use were associated with an increased level of mental health problems. The adjusted probability for mental health problems was lower for snus use; however, snus use prevalence was tenfold in our sample. IMPLICATIONS: Despite the lack of causal and directional conclusions, these associations may have implications for future legislation on snus. They also highlight the importance of more research, especially as snus is considered less harmful and seemingly replacing smoking in Norway.

Loneliness Across the COVID-19 Pandemic: Risk Factors in Norwegian Young People.

Background: There is evidence of increasing levels of loneliness in Norwegian young people before the COVID-19 pandemic. It is not clear how the COVID-19 pandemic, and the associated necessary restrictions, impacted on these trends. Aims: To examine how loneliness in young people changed across the pandemic, how loneliness relates to demographic characteristics and how different pandemic restrictions impacted loneliness. Method: We analyzed data from three waves of a Norwegian national higher education student survey (the SHoT-study). Data was examined from 2018 from a total of 49,836 students, 2021 from 62,212 students, and from 2022 from 53,362 (response rates 31-35%). Loneliness was measured by "The Three-Item Loneliness Scale" (T-ILS). Results: There was a sharp increase in loneliness from 2018 to 2021, and a reduction in levels of loneliness in 2022, although at increased levels compared to prior to the pandemic. Females consistently report higher levels of loneliness than males, with a larger difference during the peak of the pandemic. There were higher rates of loneliness in geographical regions with higher COVID rates and greater pandemic-related restrictions during 2021. Loneliness was lower among students reporting more days on campus in 2021 and for those with lectures on campus in 2022, both with dose-response associations. Conclusions: Loneliness is a major public health problem among young adults in higher education. Loneliness increased during the pandemic and has decreased but is still not back to pre-pandemic levels. The results suggest the importance of open campuses and in-person lectures, for increased social connectedness among young people.